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Alotaibi FF, Rocchietta I, Buti J, D'Aiuto F. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis. J Clin Periodontol 2023; 50:1487-1519. [PMID: 37495541 DOI: 10.1111/jcpe.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
AIM To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness. MATERIALS AND METHODS Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models. RESULTS Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG. CONCLUSIONS VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.
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Affiliation(s)
- Faisal F Alotaibi
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
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Aydin MA, Gul G, Aydin MF, Tunc Y. A real-time analysis of intraoperative interruptions in relation to use of simple preventive measures including a sign on the door and a checklist-based team brief. J Perioper Pract 2022; 32:310-319. [PMID: 34410852 DOI: 10.1177/17504589211024428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study aimed to evaluate intraoperative interruptions by frequency, type, interference and source, and preventive measures. The interruptions in the operating theatre were evaluated for 52 surgical procedures based on real-time recordings and divided into routine operative procedures (ROP, n = 26, without intervention) and intervened operative procedures (IOP, n = 26, observed after team brief and placement of a warning sign for unnecessary door openings) groups. Intervened operative procedures vs. routine operative procedures was associated with a significantly lower number of interruptions (p = 0.014). Implementation of preventive measures was associated with a significantly lower number of entrances and exits (p = 0.001) and equipment issues (p = 0.003), interruptions that affected the circulating nurse or anaesthesia technician/associate (p = 0.003) and those caused by team members other than assisting surgeon and scrub nurse (p-value ranged from 0.015 to 0.009). Our findings revealed significantly reduced interruptions after a simple preventive measure including team brief and the placement of a warning sign for unnecessary door openings.
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Affiliation(s)
- Mehmet Akif Aydin
- Department of General Surgery, Altinbas University Faculty of Medicine Medical Park Bahcelievler Hospital, Istanbul, Turkey
| | - Gungor Gul
- Clinic of General Surgery, Private Goztepe Hospital, Istanbul, Turkey
| | - Muhammet Fatih Aydin
- Department of Gastroenterology, Altinbas University Faculty of Medicine Medical Park Bahcelievler Hospital, Istanbul, Turkey
| | - Yesim Tunc
- Department of Biostatistics, Altinbas University Faculty of Medicine, Istanbul, Turkey
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Asken MJ, Hortian V, Yang HC. What do they know? What psychological skills in other professions can contribute to performance excellence in surgery. Am J Surg 2022; 224:1015-1016. [PMID: 35450746 DOI: 10.1016/j.amjsurg.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michael J Asken
- UPMC Pinnacle Hospitals, Address Suite 902, 205 South Front Street, Harrisburg, PA, 17104, USA.
| | - Vanessa Hortian
- UPMC Pinnacle Hospitals, Address Suite 902, 205 South Front Street, Harrisburg, PA, 17104, USA
| | - Harold C Yang
- UPMC Pinnacle Hospitals, Address Suite 902, 205 South Front Street, Harrisburg, PA, 17104, USA
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Comparisons between cataract surgery and aviation. Eye (Lond) 2022; 36:490-491. [PMID: 34975149 PMCID: PMC8873221 DOI: 10.1038/s41433-021-01877-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022] Open
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Compère V, Besnier E, Clavier T, Byhet N, Lefranc F, Jegou F, Sturzenegger N, Hardy JB, Dureuil B, Elie T. Evaluation of the Time Spent by Anesthetist on Clinical Tasks in the Operating Room. Front Med (Lausanne) 2022; 8:768919. [PMID: 35111774 PMCID: PMC8801532 DOI: 10.3389/fmed.2021.768919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Changes in the health system in Western countries have increased the scope of the daily tasks assigned to physicians', anesthetists included. As already shown in other specialties, increased non-clinical burden reduces the clinical time spent with patients. Methods This was a multicenter, prospective, observational study conducted in 6 public and private hospitals in France. The primary endpoint was the evaluation by an external observer of the time spent per day (in minutes) by anesthetists on clinical tasks in the operating room. Secondary endpoints were the time spent per day (in minutes) on non-clinical organizational tasks and the number of task interruptions per hour of work. Results Between October 2017 and April 2018, 54 anesthetists from six hospitals (1 public university hospital, two public general hospitals and three private hospitals) were included. They were followed for 96 days corresponding to 550 hours of work. The proportion of overall clinical time was 62% (58% 95%CI [53; 63] for direct care. The proportion of organizational time was higher in public hospitals (11% in the university hospital (p < 0.001) and 4% in general hospitals (p < 0.01)) compared to private hospitals (1%). The number of task interruptions (1.5/h ± 1.4 in all hospitals) was 4 times higher in the university hospital (2.2/h ± 1.6) compared to private hospitals (0.5/h ± 0.3) (p < 0.05). Conclusions Most time in the operating room was spent on clinical care with a significant contrast between public and private hospitals for organizational time.
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Affiliation(s)
- Vincent Compère
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
- Normandie Université, UNIROUEN, INSERM U982, Mont-Saint-Aignan, France
- *Correspondence: Vincent Compère
| | - Emmanuel Besnier
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
- Normandie Université, UNIROUEN, INSERM U982, Mont-Saint-Aignan, France
| | - Nicolas Byhet
- Department of Anaesthesiology, Dieppe General Hospital, Dieppe, France
| | - Florent Lefranc
- Department of Anaesthesiology, Hôpital privé de l'estuaire, Le Havre, France
| | - Frederic Jegou
- Department of Anaesthesiology, Clinique du Cèdre, Bois-Guillaume, France
| | | | | | - Bertrand Dureuil
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
| | - Thomas Elie
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
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Dungarwalla M, Bailey E. Dentistry and aviation engineering - behind the scenes at operations in a UK-based airline. Br Dent J 2021; 230:835-840. [PMID: 34172871 PMCID: PMC8232987 DOI: 10.1038/s41415-021-3127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022]
Abstract
The healthcare industry is commonly compared to the aviation industry with emphasis on human factors and the decision-making processes undertaken by pilots and clinicians alike. The authors have been given exclusive access to meet the head of the maintenance team behind one of the UK's most popular airlines. An open-ended interview took place which was audio-transcribed for thematic analysis. Data were initially coded to identify basic patterns in the transcript. Once this was completed, themes were identified and agreed between the authors which could be compared to healthcare and dentistry. These themes were: regulation, occupational health, maintenance of equipment, use of checklists, reporting, just culture, burnout and disturbances. The aviation engineering industry requires the combination of a skilled workforce working under time pressure often in a financially restricted environment in a similar way to healthcare, especially dentistry. The two industries share common risks, although introduction of risk management tools such as checklists have been prevalent in aviation since the 1930s. Recognition of said risks and themes can lead to shared learning opportunities to benefit both sectors. There has been substantive focus on human factors and their interaction with decision-making in healthcare. The authors present themes garnered from an interview with a base maintenance manager from one of the UK's largest airlines. There are clear overlaps between engineering and dentistry, specifically pertaining to equipment regulation, checklists and working directives.
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Affiliation(s)
- Mohammed Dungarwalla
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Oral & Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, UK.
| | - Edmund Bailey
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Oral & Maxillofacial Surgery, The Royal London Hospital, Whitechapel, London, UK
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Petrut B, Berindan-Neagoe I, Feflea DI, Hogea M, Pasca S, Bujoreanu CE, Bschleipfer T. Mental Fatigue Evaluation of Surgical Teams during a Regular Workday in a High-Volume Tertiary Healthcare Center. Urol Int 2020; 104:301-308. [PMID: 31955166 DOI: 10.1159/000504988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Considering the complex set of manual and psychological tasks a surgeon has to perform during the day, it is very important to assess the surgeon's fatigability, reaction time, attention, and memory. OBJECTIVE Here, we wanted to determine the mental fatigue status of surgeons and how their abilities are affected through a regular workday. METHODS We included 3 senior urologists and 6 urology residents. In a set period of time, we assessed their fatigue through self-assessed fatigue, Samn-Perelli score, and Karolinska sleepiness scale score. Further, reaction time, attention, and memory correlated with the number of the operations in the day, and total number of operations in that day were assessed. RESULTS As the number of tasks increases, and as the surgeons advance to the end of the workday, they become more fatigued, reaction time ultimately increases, and attention and memory become slightly altered. CONCLUSIONS Complications resulting from the fatigue of surgeons could be serious. Their performance status and skills decrease as they perform more tasks or advance through the day.
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Affiliation(s)
- Bogdan Petrut
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Dragos I Feflea
- Department of Urology, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | | | - Sergiu Pasca
- Department of Functional Genomics, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Cristina E Bujoreanu
- Department of Urology, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania,
| | - Thomas Bschleipfer
- Clinic for Urology, Andrology and Pediatric Urology, Clinics of Nordoberpfalz AG, Weiden, Germany
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Abstract
Safety in medicine is a pressing issue. It has been shown that deaths due to medical error range from 98,000 to 400,000 per year in the United States. Since this issue was broached in 1999, a variety of clinical and institutional safety interventions have been pioneered; however, the medical community has realized that without a strong institutional safety culture, the efficacy of these interventions is limited. Changing culture is often a long and difficult process. Just as the wider medical community slowly moves towards the practice of safety culture, interventional radiology must uphold a culture of safety along with its other core tenets throughout its continued evolution. The Agency for Healthcare Research and Quality provides many effective evidence-based training programs to help in the process of improving safety culture. Herein, we focus on the Agency for Healthcare Research and Quality's comprehensive unit-based safety program and Team Strategies and Tools to Enhance Performance and Patient Safety programs and how they pertain to the interventional radiology setting. We also highlight key concepts that should be considered when embarking on an institutional cultural change. Finally, we focus on the role of safety culture as it pertains to those healthcare providers affected in the aftermath of an error, the "second victims."
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Affiliation(s)
| | - Robert Dixon
- Program Director Vascular Interventional Radiology, University of North Carolina at Chapel Hill, Campus Box 7510, Chapel Hill, NC.
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Abstract
Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.
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Affiliation(s)
- Mark H Wilson
- Institute of Pre-Hospital Care, London's Air Ambulance, The Royal London Hospital, London, UK; St Mary's Major Trauma Centre, Imperial College, London, UK.
| | - Karel Habig
- Greater Sydney HEMS Service, Sydney, Australia
| | | | - Amy Hughes
- Institute of Pre-Hospital Care, London's Air Ambulance, The Royal London Hospital, London, UK
| | - Gareth Davies
- Institute of Pre-Hospital Care, London's Air Ambulance, The Royal London Hospital, London, UK
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